Lan Xu, Jinjun Ran, Hui Shao, Meng Chen, Hao Tang, Yongxuan Li, Yaqing Xu, Yue Huang, Feng Tao, Zhenxiu Liu, Victor W. Zhong
OBJECTIVE To estimate the incidence and identify risk factors for diagnosed type 2 diabetes (T2D) among young U.S. adults. RESEARCH DESIGN AND METHODS We analyzed 142,884 adults aged 18–79 years with self-reported diabetes type from the cross-sectional National Health Interview Survey in 2016–2022, representing the noninstitutionalized U.S. civilian population. Incidence of diagnosed T2D was calculated for three age groups: young-adult onset (18–44 years), middle-age onset (45–64 years), and older-adult onset (65–79 years); the latter two groups were included to highlight the distinct risk factor profile of young-adult-onset T2D. Multivariable logistic regressions were used to identify risk factors for young-adult-onset T2D. RESULTS The estimated incidence of diagnosed young-adult-onset T2D was 3.0 per 1000 adults (95% CI 2.6–3.5). Minority groups, socioeconomically disadvantaged individuals, and people with cardiometabolic diseases or psychological conditions had a higher incidence of diagnosed young-adult-onset T2D compared with their counterparts. Lipid-lowering medication use (adjusted odds ratio [aOR] 13.15, 95% CI 8.85–19.55), antihypertensive medication use (aOR 11.89, 95% CI 7.97–17.73), and obesity (BMI ≥30 vs. <25 kg/m2, aOR 10.89, 95% CI 6.69–17.7) were the strongest risk factors for young-adult-onset T2D; these risk factors, along with hypertension, hyperlipidemia, and coronary heart disease, were more strongly associated with young-adult-onset T2D compared with later-onset T2D, with up to 4.5 times higher aORs. CONCLUSIONS This study quantified the incidence of diagnosed young-adult-onset T2D in U.S. adults and identified its distinct risk factor profile. Targeted prevention strategies for young-adult-onset T2D are needed for minority and socioeconomically disadvantaged people and those with cardiometabolic diseases.
目的：评估美国年轻成人诊断为2型糖尿病（T2D）的发病率并确定危险因素。研究设计和方法我们分析了2016-2022年全国健康访谈调查中自我报告糖尿病类型的142,884名18-79岁的成年人，代表了非机构的美国平民人口。计算三个年龄组确诊T2D的发病率：青壮年发病（18-44岁）、中年发病（45-64岁）和老年发病（65-79岁）；后两组被纳入是为了强调年轻人发病的T2D的独特风险因素。采用多变量logistic回归来确定年轻人发病T2D的危险因素。结果诊断为年轻成人发病的T2D的估计发病率为每1000名成人3.0例（95% CI 2.6-3.5）。与同龄人相比，少数群体、社会经济上处于不利地位的个体以及患有心脏代谢疾病或心理疾病的人诊断为青壮年发病的T2D的发病率更高。使用降脂药物（调整比值比[aOR] 13.15, 95% CI 8.85-19.55）、使用降压药（aOR 11.89, 95% CI 7.97-17.73）和肥胖（BMI≥30 vs. 25 kg/m2, aOR 10.89, 95% CI 6.69-17.7）是青壮年发病T2D的最强危险因素；这些危险因素，以及高血压、高脂血症和冠心病，与后发T2D相比，与青壮年发病的T2D相关性更强，aORs高达4.5倍。结论：本研究量化了美国成年人中诊断为年轻成人发病的T2D的发病率，并确定了其独特的危险因素概况。少数民族和社会经济弱势群体以及患有心脏代谢疾病的人需要针对年轻人发病的T2D的有针对性的预防策略。
{"title":"Incidence and Risk Factors of Diagnosed Young-Adult-Onset Type 2 Diabetes in the U.S.: The National Health Interview Survey 2016–2022","authors":"Lan Xu, Jinjun Ran, Hui Shao, Meng Chen, Hao Tang, Yongxuan Li, Yaqing Xu, Yue Huang, Feng Tao, Zhenxiu Liu, Victor W. Zhong","doi":"10.2337/dc24-1699","DOIUrl":"https://doi.org/10.2337/dc24-1699","url":null,"abstract":"OBJECTIVE To estimate the incidence and identify risk factors for diagnosed type 2 diabetes (T2D) among young U.S. adults. RESEARCH DESIGN AND METHODS We analyzed 142,884 adults aged 18–79 years with self-reported diabetes type from the cross-sectional National Health Interview Survey in 2016–2022, representing the noninstitutionalized U.S. civilian population. Incidence of diagnosed T2D was calculated for three age groups: young-adult onset (18–44 years), middle-age onset (45–64 years), and older-adult onset (65–79 years); the latter two groups were included to highlight the distinct risk factor profile of young-adult-onset T2D. Multivariable logistic regressions were used to identify risk factors for young-adult-onset T2D. RESULTS The estimated incidence of diagnosed young-adult-onset T2D was 3.0 per 1000 adults (95% CI 2.6–3.5). Minority groups, socioeconomically disadvantaged individuals, and people with cardiometabolic diseases or psychological conditions had a higher incidence of diagnosed young-adult-onset T2D compared with their counterparts. Lipid-lowering medication use (adjusted odds ratio [aOR] 13.15, 95% CI 8.85–19.55), antihypertensive medication use (aOR 11.89, 95% CI 7.97–17.73), and obesity (BMI ≥30 vs. &lt;25 kg/m2, aOR 10.89, 95% CI 6.69–17.7) were the strongest risk factors for young-adult-onset T2D; these risk factors, along with hypertension, hyperlipidemia, and coronary heart disease, were more strongly associated with young-adult-onset T2D compared with later-onset T2D, with up to 4.5 times higher aORs. CONCLUSIONS This study quantified the incidence of diagnosed young-adult-onset T2D in U.S. adults and identified its distinct risk factor profile. Targeted prevention strategies for young-adult-onset T2D are needed for minority and socioeconomically disadvantaged people and those with cardiometabolic diseases.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"11 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Harshal Deshmukh, Emma G. Wilmot, Pratik Choudhary, Emmanuel Ssemmondo, Dennis Barnes, Neil Walker, Chris Walton, Robert E.J. Ryder, Thozhukat Sathyapalan
OBJECTIVE This study aimed to explore the relationship between time below range (TBR), impaired awareness of hypoglycemia (IAH), and severe hypoglycemia (SH). RESEARCH DESIGN AND METHODS This cross-sectional study analyzed data from individuals with diabetes using continuous glucose monitors (CGMs) in the Association of British Clinical Diabetologists audit. Hypoglycemia awareness was assessed via the Gold score (≥4 denoting IAH), and SH was defined as hypoglycemia requiring third-party assistance. Logistic regression was used to determine the association between TBR percentage (<70 mg/dL; 3.9 mmol/L) at first follow-up and follow-up Gold score and SH incidence. The Youden J index identified optimal TBR percentage cutoffs for detecting IAH and SH. RESULTS The study included 15,777 participants, with follow-up TBR and SH data available for 5,029. The median TBR percentage was 4% (interquartile range 2–6.6%), with 42% meeting the recommended TBR of ≤4%. Adjusted for age, sex, and BMI, TBR was significantly associated with SH (P < 0.001) and IAH (P = 0.005). Optimal TBR cutoffs for identifying IAH and SH were 3.35% and 3.95%, yielding negative predictive value (NPV) values of 85% and 97%, respectively. CONCLUSIONS Our findings support the international consensus recommending a TBR of <4% in type 1 diabetes, with high NPV values suggesting the utility of TBR in screening for SH.
{"title":"Time Below Range and Its Influence on Hypoglycemia Awareness and Severe Hypoglycemia: Insights From the Association of British Clinical Diabetologists Study","authors":"Harshal Deshmukh, Emma G. Wilmot, Pratik Choudhary, Emmanuel Ssemmondo, Dennis Barnes, Neil Walker, Chris Walton, Robert E.J. Ryder, Thozhukat Sathyapalan","doi":"10.2337/dc24-1833","DOIUrl":"https://doi.org/10.2337/dc24-1833","url":null,"abstract":"OBJECTIVE This study aimed to explore the relationship between time below range (TBR), impaired awareness of hypoglycemia (IAH), and severe hypoglycemia (SH). RESEARCH DESIGN AND METHODS This cross-sectional study analyzed data from individuals with diabetes using continuous glucose monitors (CGMs) in the Association of British Clinical Diabetologists audit. Hypoglycemia awareness was assessed via the Gold score (≥4 denoting IAH), and SH was defined as hypoglycemia requiring third-party assistance. Logistic regression was used to determine the association between TBR percentage (&lt;70 mg/dL; 3.9 mmol/L) at first follow-up and follow-up Gold score and SH incidence. The Youden J index identified optimal TBR percentage cutoffs for detecting IAH and SH. RESULTS The study included 15,777 participants, with follow-up TBR and SH data available for 5,029. The median TBR percentage was 4% (interquartile range 2–6.6%), with 42% meeting the recommended TBR of ≤4%. Adjusted for age, sex, and BMI, TBR was significantly associated with SH (P &lt; 0.001) and IAH (P = 0.005). Optimal TBR cutoffs for identifying IAH and SH were 3.35% and 3.95%, yielding negative predictive value (NPV) values of 85% and 97%, respectively. CONCLUSIONS Our findings support the international consensus recommending a TBR of &lt;4% in type 1 diabetes, with high NPV values suggesting the utility of TBR in screening for SH.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"18 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142917177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caroline G. Borden, Baylee F. Bakkila, Laura M. Nally, Kasia J. Lipska
OBJECTIVE To examine the association between insulin rationing and health care utilization. RESEARCH DESIGN AND METHODS Cross-sectional study of all 2021 National Health Interview Survey respondents with diabetes using insulin. Logistic regression and zero-inflated negative binomial regression models examined associations between insulin rationing (skipping, delaying, or reducing insulin to save money) and 1) emergency department (ED) visit or hospitalization and 2) number of urgent care visits. All analyses were age-stratified and used survey weights. RESULTS Among 982 respondents representing 7,593,944 U.S. adults (median age 61, 47% women), 17% reported rationing. Among adults 18–64, rationing was not significantly associated with health care utilization. Among adults ≥65, rationing was associated with more urgent care visits (relative risk 2.1, 95% CI 1.2–3.6) but not with odds of ED visit or hospitalization (odds ratio 0.7, 95% CI 0.3–1.4). CONCLUSIONS Insulin rationing was not associated with higher health care utilization, but concurrent rationing of health care may mask a relationship.
目的探讨胰岛素配给与医疗保健利用的关系。研究设计和方法对2021名使用胰岛素的糖尿病患者进行横断面研究。Logistic回归和零膨胀负二项回归模型检验了胰岛素配给（跳过、延迟或减少胰岛素以节省资金）与1)急诊科（ED）就诊或住院以及2)急诊就诊次数之间的关系。所有分析均按年龄分层，并使用调查权重。结果：在982名受访者中，有7593944名美国成年人（中位年龄61岁，女性占47%），17%的人报告了定量配给。在18-64岁的成年人中，配给制与卫生保健利用无显著相关。在65岁以上的成年人中，定量配给与更多的紧急护理就诊相关（相对风险2.1,95% CI 1.2-3.6），但与急诊科就诊或住院的几率无关（优势比0.7,95% CI 0.3-1.4）。结论：胰岛素配给与较高的医疗保健利用率无关，但同时配给医疗保健可能掩盖了两者之间的关系。
{"title":"The Association Between Cost-Related Insulin Rationing and Health Care Utilization in U.S. Adults With Diabetes","authors":"Caroline G. Borden, Baylee F. Bakkila, Laura M. Nally, Kasia J. Lipska","doi":"10.2337/dc24-2117","DOIUrl":"https://doi.org/10.2337/dc24-2117","url":null,"abstract":"OBJECTIVE To examine the association between insulin rationing and health care utilization. RESEARCH DESIGN AND METHODS Cross-sectional study of all 2021 National Health Interview Survey respondents with diabetes using insulin. Logistic regression and zero-inflated negative binomial regression models examined associations between insulin rationing (skipping, delaying, or reducing insulin to save money) and 1) emergency department (ED) visit or hospitalization and 2) number of urgent care visits. All analyses were age-stratified and used survey weights. RESULTS Among 982 respondents representing 7,593,944 U.S. adults (median age 61, 47% women), 17% reported rationing. Among adults 18–64, rationing was not significantly associated with health care utilization. Among adults ≥65, rationing was associated with more urgent care visits (relative risk 2.1, 95% CI 1.2–3.6) but not with odds of ED visit or hospitalization (odds ratio 0.7, 95% CI 0.3–1.4). CONCLUSIONS Insulin rationing was not associated with higher health care utilization, but concurrent rationing of health care may mask a relationship.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"17 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142917031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ellen M. Apperloo, Katherine R. Tuttle, Imre Pavo, Axel Haupt, Rebecca Taylor, Russell J. Wiese, Andrea Hemmingway, David Z. I. Cherney, Naveed Sattar, Hiddo J. L. Heerspink
OBJECTIVE Tirzepatide, a long-acting, glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 receptor agonist, reduced urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) decline in people with type 2 diabetes and high cardiovascular risk in the SURPASS-4 trial. To examine the generalizability of these findings, we assessed change from baseline in UACR for tirzepatide (5, 10, and 15 mg) compared with active and placebo treatment in a broad population from the SURPASS-1–5 trials. RESEARCH DESIGN AND METHODS This post hoc analysis examined data from the overall pooled SURPASS-1–5 population and subgroups defined by baseline UACR ≥30 mg/g. A mixed model for repeated measures was used to analyze on-treatment data from baseline to the end-of-treatment visit. Study identifier was included in the model as a covariate. RESULTS The adjusted mean percent change from baseline in UACR for tirzepatide 5, 10, or 15 mg compared with all pooled comparators was −19.3% (95% CI −25.5, −12.5), −22.0% (−28.1, −15.3), and −26.3 (−32.0, −20.0), respectively, at week 40/42. Results were similar across pooled placebo, active, and insulin comparator studies. UACR lowering appeared more pronounced in subgroups with UACR ≥30 mg/g. Mediation analysis findings suggested that approximately one-half of the reduction in albuminuria associated with tirzepatide may be weight loss related. There was no difference in eGFR between tirzepatide and pooled comparators at week 40/42. CONCLUSIONS In this post hoc analysis in people with type 2 diabetes, including those with chronic kidney disease, tirzepatide was associated with a clinically relevant decreased UACR versus comparators, suggesting a potential kidney-protective effect.
{"title":"Tirzepatide Associated With Reduced Albuminuria in Participants With Type 2 Diabetes: Pooled Post Hoc Analysis From the Randomized Active- and Placebo-Controlled SURPASS-1–5 Clinical Trials","authors":"Ellen M. Apperloo, Katherine R. Tuttle, Imre Pavo, Axel Haupt, Rebecca Taylor, Russell J. Wiese, Andrea Hemmingway, David Z. I. Cherney, Naveed Sattar, Hiddo J. L. Heerspink","doi":"10.2337/dc24-1773","DOIUrl":"https://doi.org/10.2337/dc24-1773","url":null,"abstract":"OBJECTIVE Tirzepatide, a long-acting, glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 receptor agonist, reduced urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) decline in people with type 2 diabetes and high cardiovascular risk in the SURPASS-4 trial. To examine the generalizability of these findings, we assessed change from baseline in UACR for tirzepatide (5, 10, and 15 mg) compared with active and placebo treatment in a broad population from the SURPASS-1–5 trials. RESEARCH DESIGN AND METHODS This post hoc analysis examined data from the overall pooled SURPASS-1–5 population and subgroups defined by baseline UACR ≥30 mg/g. A mixed model for repeated measures was used to analyze on-treatment data from baseline to the end-of-treatment visit. Study identifier was included in the model as a covariate. RESULTS The adjusted mean percent change from baseline in UACR for tirzepatide 5, 10, or 15 mg compared with all pooled comparators was −19.3% (95% CI −25.5, −12.5), −22.0% (−28.1, −15.3), and −26.3 (−32.0, −20.0), respectively, at week 40/42. Results were similar across pooled placebo, active, and insulin comparator studies. UACR lowering appeared more pronounced in subgroups with UACR ≥30 mg/g. Mediation analysis findings suggested that approximately one-half of the reduction in albuminuria associated with tirzepatide may be weight loss related. There was no difference in eGFR between tirzepatide and pooled comparators at week 40/42. CONCLUSIONS In this post hoc analysis in people with type 2 diabetes, including those with chronic kidney disease, tirzepatide was associated with a clinically relevant decreased UACR versus comparators, suggesting a potential kidney-protective effect.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"27 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142917032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marko Barovic, Joke Johanna Hahn, Annett Heinrich, Trishla Adhikari, Peter Schwarz, Peter Mirtschink, Alexander Funk, Stefan Kabisch, Andreas F.H. Pfeiffer, Matthias Blüher, Jochen Seissler, Norbert Stefan, Robert Wagner, Andreas Fritsche, Reiner Jumpertz von Schwartzenberg, Sarantis Chlamydas, Hani Harb, Christos S. Mantzoros, Triantafyllos Chavakis, Annette Schürmann, Andreas L. Birkenfeld, Michael Roden, Michele Solimena, Stefan R. Bornstein, Nikolaos Perakakis
OBJECTIVE Progression of prediabetes to type 2 diabetes has been associated with β-cell dysfunction, whereas its remission to normoglycemia has been related to improvement of insulin sensitivity. To understand the mechanisms and identify potential biomarkers related to prediabetes trajectories, we compared the proteomics and metabolomics profile of people with prediabetes progressing to diabetes or reversing to normoglycemia within 1 year. RESEARCH DESIGN AND METHODS The fasting plasma concentrations of 1,389 proteins and the fasting, 30-min, and 120-min post–oral glucose tolerance test (OGTT) plasma concentrations of 152 metabolites were measured in up to 134 individuals with new-onset diabetes, prediabetes, or normal glucose tolerance. For 108 participants, the analysis was repeated with samples from 1 year before, when all had prediabetes. RESULTS The plasma concentrations of 14 proteins were higher in diabetes compared with normoglycemia in a population with prediabetes 1 year before, and they correlated with indices of insulin sensitivity. Higher levels of dicarbonyl/L-xylulose reductase and glutathione S-transferase A3 in the prediabetic state were associated with an increased risk of diabetes 1 year later. Pathway analysis pointed toward differences in immune response between diabetes and normoglycemia that were already recognizable in the prediabetic state 1 year prior at baseline. The area under the curve during OGTT of the concentrations of IDL particles, IDL apolipoprotein B, and IDL cholesterol was higher in new-onset diabetes compared with normoglycemia. The concentration of glutamate increased in prediabetes progressing to diabetes. CONCLUSIONS We identify new candidates associated with the progression of prediabetes to diabetes or its remission to normoglycemia. Pathways regulating the immune response are related to prediabetes trajectories.
糖尿病前期发展为2型糖尿病与β细胞功能障碍有关，而其缓解到正常血糖水平与胰岛素敏感性的改善有关。为了了解机制并确定与前驱糖尿病相关的潜在生物标志物，我们比较了1年内进展为糖尿病或逆转为正常血糖的前驱糖尿病患者的蛋白质组学和代谢组学特征。研究设计和方法对134例新发糖尿病、前驱糖尿病或正常糖耐量患者进行空腹血浆1389种蛋白质浓度和口服糖耐量试验（OGTT）后空腹、30分钟和120分钟血浆152种代谢物浓度的测定。对108名参与者重复分析了一年前的样本，当时他们都患有前驱糖尿病。结果糖尿病患者1年前血浆中14种蛋白浓度高于血糖正常者，且与胰岛素敏感性指标相关。糖尿病前期二羰基/ l -木糖还原酶和谷胱甘肽s -转移酶A3水平升高与1年后糖尿病风险增加有关。途径分析指出糖尿病和正常血糖之间的免疫反应差异，这在1年前的糖尿病前期就已经可以识别。OGTT时IDL颗粒、IDL载脂蛋白B和IDL胆固醇浓度曲线下面积在新发糖尿病患者中高于正常血糖患者。糖尿病前期发展为糖尿病时谷氨酸浓度升高。结论：我们确定了与糖尿病前期进展到糖尿病或其缓解到正常血糖相关的新候选药物。调节免疫反应的途径与前驱糖尿病的轨迹有关。
{"title":"Proteomic and Metabolomic Signatures in Prediabetes Progressing to Diabetes or Reversing to Normoglycemia Within 1 Year","authors":"Marko Barovic, Joke Johanna Hahn, Annett Heinrich, Trishla Adhikari, Peter Schwarz, Peter Mirtschink, Alexander Funk, Stefan Kabisch, Andreas F.H. Pfeiffer, Matthias Blüher, Jochen Seissler, Norbert Stefan, Robert Wagner, Andreas Fritsche, Reiner Jumpertz von Schwartzenberg, Sarantis Chlamydas, Hani Harb, Christos S. Mantzoros, Triantafyllos Chavakis, Annette Schürmann, Andreas L. Birkenfeld, Michael Roden, Michele Solimena, Stefan R. Bornstein, Nikolaos Perakakis","doi":"10.2337/dc24-1412","DOIUrl":"https://doi.org/10.2337/dc24-1412","url":null,"abstract":"OBJECTIVE Progression of prediabetes to type 2 diabetes has been associated with β-cell dysfunction, whereas its remission to normoglycemia has been related to improvement of insulin sensitivity. To understand the mechanisms and identify potential biomarkers related to prediabetes trajectories, we compared the proteomics and metabolomics profile of people with prediabetes progressing to diabetes or reversing to normoglycemia within 1 year. RESEARCH DESIGN AND METHODS The fasting plasma concentrations of 1,389 proteins and the fasting, 30-min, and 120-min post–oral glucose tolerance test (OGTT) plasma concentrations of 152 metabolites were measured in up to 134 individuals with new-onset diabetes, prediabetes, or normal glucose tolerance. For 108 participants, the analysis was repeated with samples from 1 year before, when all had prediabetes. RESULTS The plasma concentrations of 14 proteins were higher in diabetes compared with normoglycemia in a population with prediabetes 1 year before, and they correlated with indices of insulin sensitivity. Higher levels of dicarbonyl/L-xylulose reductase and glutathione S-transferase A3 in the prediabetic state were associated with an increased risk of diabetes 1 year later. Pathway analysis pointed toward differences in immune response between diabetes and normoglycemia that were already recognizable in the prediabetic state 1 year prior at baseline. The area under the curve during OGTT of the concentrations of IDL particles, IDL apolipoprotein B, and IDL cholesterol was higher in new-onset diabetes compared with normoglycemia. The concentration of glutamate increased in prediabetes progressing to diabetes. CONCLUSIONS We identify new candidates associated with the progression of prediabetes to diabetes or its remission to normoglycemia. Pathways regulating the immune response are related to prediabetes trajectories.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"24 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142917030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Barbara H. Bardenheier, John D. Omura, Jinan B. Saaddine, Israel Hora, Kai McKeever Bullard
OBJECTIVE To compare the prevalence of diagnosed diabetes among U.S. adults with and without disabilities, overall and by subgroups. RESEARCH DESIGN AND METHODS We used data on adults aged ≥18 years from the cross-sectional 2021–2022 National Health Interview Survey to report the prevalence of diagnosed diabetes by functional disability status and for each disability type (hearing, seeing, mobility, cognition, self-care, and communication) separately. With use of the Washington Group Short Set on Functioning indicator, disability was defined according to the categories of milder (reporting some difficulty), moderate (reporting a lot of difficulty), and severe (cannot do at all) by disability type. Crude prevalence and age-standardized prevalence of diabetes were also calculated for adults with any difficulty with any disability by age, sex, race/ethnicity, education, insurance, and poverty-to-income ratio. RESULTS Diabetes prevalence increased with number of disability types, was lower among adults with no disability (5.8%) than among those with milder (9.5%) or moderate to more severe (18.3%) disability, and was 4.0–10.3 percentage points higher among those with moderate to more severe disability than among those with milder disability for vision, hearing, mobility, and cognitive disabilities. Diabetes prevalence was similar for adults with milder and moderate to more severe self-care and communication disabilities. CONCLUSIONS Prevalence of diabetes was higher among adults with any functional disability than without and increased with increasing number of disability types. Adults with multiple disability types, or those who have difficulty with self-care or communication or other moderate to more severe disabilities, may benefit from diabetes prevention programs.
目的比较美国有残疾和无残疾成人诊断糖尿病的总体和亚组患病率。研究设计和方法：我们使用来自2021-2022年全国健康访谈调查（National Health Interview Survey）的年龄≥18岁的成年人数据，根据功能残疾状况和每种残疾类型（听力、视觉、活动能力、认知、自我护理和沟通）分别报告诊断为糖尿病的患病率。使用华盛顿小组功能指标短集，残疾根据残疾类型分为轻度（报告一些困难），中度（报告很多困难）和严重（根本不能做）三类。根据年龄、性别、种族/民族、教育程度、保险和贫困收入比，计算患有任何残疾和有任何困难的成年人的糖尿病粗患病率和年龄标准化患病率。结果糖尿病患病率随着残疾类型的增加而增加，无残疾的成年人患病率（5.8%）低于轻度残疾（9.5%）或中度至重度残疾（18.3%）的成年人，中度至重度残疾的成年人患病率比视力、听力、行动能力和认知障碍的成年人患病率高4.0-10.3个百分点。患有轻度、中度至重度自我照顾和沟通障碍的成年人的糖尿病患病率相似。结论：糖尿病的患病率在任何功能残疾的成年人中都高于无功能残疾的成年人，并且随着残疾类型的增加而增加。患有多种残疾类型的成年人，或者那些在自我照顾或沟通方面有困难的人，或者其他中度到更严重残疾的人，可能会从糖尿病预防项目中受益。
{"title":"Prevalence of Diagnosed Diabetes Among U.S. Adults Aged ≥18 Years With Disabilities, 2021–2022","authors":"Barbara H. Bardenheier, John D. Omura, Jinan B. Saaddine, Israel Hora, Kai McKeever Bullard","doi":"10.2337/dci24-0086","DOIUrl":"https://doi.org/10.2337/dci24-0086","url":null,"abstract":"OBJECTIVE To compare the prevalence of diagnosed diabetes among U.S. adults with and without disabilities, overall and by subgroups. RESEARCH DESIGN AND METHODS We used data on adults aged ≥18 years from the cross-sectional 2021–2022 National Health Interview Survey to report the prevalence of diagnosed diabetes by functional disability status and for each disability type (hearing, seeing, mobility, cognition, self-care, and communication) separately. With use of the Washington Group Short Set on Functioning indicator, disability was defined according to the categories of milder (reporting some difficulty), moderate (reporting a lot of difficulty), and severe (cannot do at all) by disability type. Crude prevalence and age-standardized prevalence of diabetes were also calculated for adults with any difficulty with any disability by age, sex, race/ethnicity, education, insurance, and poverty-to-income ratio. RESULTS Diabetes prevalence increased with number of disability types, was lower among adults with no disability (5.8%) than among those with milder (9.5%) or moderate to more severe (18.3%) disability, and was 4.0–10.3 percentage points higher among those with moderate to more severe disability than among those with milder disability for vision, hearing, mobility, and cognitive disabilities. Diabetes prevalence was similar for adults with milder and moderate to more severe self-care and communication disabilities. CONCLUSIONS Prevalence of diabetes was higher among adults with any functional disability than without and increased with increasing number of disability types. Adults with multiple disability types, or those who have difficulty with self-care or communication or other moderate to more severe disabilities, may benefit from diabetes prevention programs.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"367 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142917055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexander Kutz, Dae Hyun Kim, Jun Liu, Medha N. Munshi, Elisabetta Patorno
OBJECTIVE To assess prescribing trends of antidiabetes medications in the last year of life among older adults with type 2 diabetes (T2D) and explore whether frailty is associated with differential prescribing. RESEARCH DESIGN AND METHODS In this observational cohort study of Medicare beneficiaries aged ≥67 years (2015–2019) with T2D, we assessed temporal trends in prescribing an antidiabetes medication, stratified by frailty. The main outcome included antidiabetes medication fills within 1 year of death. RESULTS Among 975,407 community-dwelling Medicare beneficiaries with T2D, the use of antidiabetes medications within 1 year of death slightly increased from 71.4% during the first 6-month period in 2015 to 72.9% (standardized mean difference [SMD] −0.03) during the second 6-month period in 2019. The most pronounced increase in use was observed for metformin (40.7% to 46.5%, SMD −0.12), whereas the largest decrease was observed for sulfonylureas (37.0% to 31.8%, SMD 0.11). Overall antidiabetes medication use decreased from 66.1% in the 9 to 12 months before death to 60.8% in the last 4 months of life (SMD 0.11; P < 0.01), driven by reduced noninsulin medication use. The use of short-acting and long-acting insulin both increased near death, with frailer individuals more likely to receive insulin. Sodium–glucose cotransporter-2 inhibitors and glucagon-like peptide 1 receptor agonists, although less common, became more frequent in more recent years. CONCLUSIONS The use of antidiabetes medications declined in the last year of life, mainly due to reduced noninsulin use. Insulin use increased near death, particularly among frailer individuals, highlighting the need for careful end-of-life management.
{"title":"Prescribing Trends of Antidiabetes Medications Near End-of-Life Among Adults With Type 2 Diabetes: A Cohort Study","authors":"Alexander Kutz, Dae Hyun Kim, Jun Liu, Medha N. Munshi, Elisabetta Patorno","doi":"10.2337/dc24-1795","DOIUrl":"https://doi.org/10.2337/dc24-1795","url":null,"abstract":"OBJECTIVE To assess prescribing trends of antidiabetes medications in the last year of life among older adults with type 2 diabetes (T2D) and explore whether frailty is associated with differential prescribing. RESEARCH DESIGN AND METHODS In this observational cohort study of Medicare beneficiaries aged ≥67 years (2015–2019) with T2D, we assessed temporal trends in prescribing an antidiabetes medication, stratified by frailty. The main outcome included antidiabetes medication fills within 1 year of death. RESULTS Among 975,407 community-dwelling Medicare beneficiaries with T2D, the use of antidiabetes medications within 1 year of death slightly increased from 71.4% during the first 6-month period in 2015 to 72.9% (standardized mean difference [SMD] −0.03) during the second 6-month period in 2019. The most pronounced increase in use was observed for metformin (40.7% to 46.5%, SMD −0.12), whereas the largest decrease was observed for sulfonylureas (37.0% to 31.8%, SMD 0.11). Overall antidiabetes medication use decreased from 66.1% in the 9 to 12 months before death to 60.8% in the last 4 months of life (SMD 0.11; P &lt; 0.01), driven by reduced noninsulin medication use. The use of short-acting and long-acting insulin both increased near death, with frailer individuals more likely to receive insulin. Sodium–glucose cotransporter-2 inhibitors and glucagon-like peptide 1 receptor agonists, although less common, became more frequent in more recent years. CONCLUSIONS The use of antidiabetes medications declined in the last year of life, mainly due to reduced noninsulin use. Insulin use increased near death, particularly among frailer individuals, highlighting the need for careful end-of-life management.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"4 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142917058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sung Eun Kim, Kyungdo Han, Won Kyoung Cho, Byung-Kyu Suh
OBJECTIVE To explore all-cause mortality and the incidence of cardiovascular and renal complications among patients with young-onset diabetes in South Korea using a nationwide registry database. RESEARCH DESIGN AND METHODS Data were collected from the Korean National Health Insurance Service–National Sample Cohort database from 2006 to 2019 for patients aged ≤30 years with type 1 (T1D) or 2 diabetes (T2D). The incidence rates of cardiovascular complications (myocardial infarction [MI] and stroke) and kidney failure, as well as all-cause mortality, were compared with those in the general population. RESULTS This study included 513,633 participants, comprising 413 with T1D, 1,250 with T2D, and 511,970 controls. After adjusting for sex, age, family income, hypertension, and dyslipidemia, the hazard ratio (HR) for MI was 6.76 (95% CI 2.44–18.72) and 5.07 (95% CI 2.48–10.36) for T1D and T2D, respectively. The HR for stroke was 4.65 (95% CI 1.70–12.71) and 3.30 (95% CI 1.67–6.53) for T1D and T2D, respectively. The HR for kidney failure was 20.92 (95% CI 11.40–38.39) and 2.78 (95% CI 1.37–5.64) for T1D and T2D, respectively. The mortality risk was significantly higher in patients with T1D (3.69; 95% CI 1.95–6.98) and T2D (3.06; 95% CI 2.02–4.63) than in the control group. The mortality risk was highest in the T2D subgroup of participants aged <20 years at enrollment (10.70; 95% CI 4.41–25.94). CONCLUSIONS In South Korea, patients with young-onset diabetes are at high risk of cardiovascular complications, kidney failure, and death.
目的：利用一个全国性的登记数据库，探讨韩国年轻发病糖尿病患者的全因死亡率和心血管及肾脏并发症发生率。研究设计和方法从2006年至2019年韩国国民健康保险服务国家样本队列数据库中收集年龄≤30岁的1型（T1D）或2型糖尿病（T2D）患者的数据。心血管并发症（心肌梗死[MI]和中风）和肾衰竭的发生率以及全因死亡率与普通人群进行比较。结果：本研究纳入513,633名参与者，其中413名T1D患者，1,250名T2D患者和511,970名对照组。在调整性别、年龄、家庭收入、高血压和血脂异常等因素后，T1D和T2D的MI风险比（HR）分别为6.76 （95% CI 2.44-18.72）和5.07 （95% CI 2.48-10.36）。T1D和T2D的卒中HR分别为4.65 （95% CI 1.70-12.71）和3.30 （95% CI 1.67-6.53）。T1D和T2D肾衰竭的HR分别为20.92 （95% CI 11.40-38.39）和2.78 （95% CI 1.37-5.64）。T1D患者的死亡风险明显更高(3.69；95% CI 1.95-6.98)和T2D (3.06；95% CI 2.02-4.63)。T2D亚组的死亡风险最高，受试者入组时年龄为18 ~ 20岁(10.70；95% ci 4.41-25.94)。结论：在韩国，年轻发病的糖尿病患者心血管并发症、肾衰竭和死亡的风险较高。
{"title":"Cardiovascular Complications, Kidney Failure, and Mortality in Young-Onset Type 1 and 2 Diabetes: Data From the Korean National Health Insurance Service","authors":"Sung Eun Kim, Kyungdo Han, Won Kyoung Cho, Byung-Kyu Suh","doi":"10.2337/dc24-1023","DOIUrl":"https://doi.org/10.2337/dc24-1023","url":null,"abstract":"OBJECTIVE To explore all-cause mortality and the incidence of cardiovascular and renal complications among patients with young-onset diabetes in South Korea using a nationwide registry database. RESEARCH DESIGN AND METHODS Data were collected from the Korean National Health Insurance Service–National Sample Cohort database from 2006 to 2019 for patients aged ≤30 years with type 1 (T1D) or 2 diabetes (T2D). The incidence rates of cardiovascular complications (myocardial infarction [MI] and stroke) and kidney failure, as well as all-cause mortality, were compared with those in the general population. RESULTS This study included 513,633 participants, comprising 413 with T1D, 1,250 with T2D, and 511,970 controls. After adjusting for sex, age, family income, hypertension, and dyslipidemia, the hazard ratio (HR) for MI was 6.76 (95% CI 2.44–18.72) and 5.07 (95% CI 2.48–10.36) for T1D and T2D, respectively. The HR for stroke was 4.65 (95% CI 1.70–12.71) and 3.30 (95% CI 1.67–6.53) for T1D and T2D, respectively. The HR for kidney failure was 20.92 (95% CI 11.40–38.39) and 2.78 (95% CI 1.37–5.64) for T1D and T2D, respectively. The mortality risk was significantly higher in patients with T1D (3.69; 95% CI 1.95–6.98) and T2D (3.06; 95% CI 2.02–4.63) than in the control group. The mortality risk was highest in the T2D subgroup of participants aged &lt;20 years at enrollment (10.70; 95% CI 4.41–25.94). CONCLUSIONS In South Korea, patients with young-onset diabetes are at high risk of cardiovascular complications, kidney failure, and death.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"85 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142879712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natalie R. Daya, Michael Fang, Dan Wang, Arielle Valint, B. Gwen Windham, Josef Coresh, Justin B. Echouffo-Tcheugui, Elizabeth Selvin
OBJECTIVE To characterize the prevalence of continuous glucose monitoring (CGM)-defined glucose abnormalities in a large, community-based population of very old adults (>75 years). RESEARCH DESIGN AND METHODS A cross-sectional analysis of 1,150 older adults with and without diabetes who attended the Atherosclerosis Risk in Communities Study (2021–2022). Diabetes was based on a self-reported diagnosis of diabetes by a health care provider, use of diabetes medication, or a hemoglobin A1c (HbA1c) ≥6.5%. Prediabetes was defined as an HbA1c of 5.7% to <6.5% and normoglycemia as an HbA1c of <5.7%. We analyzed CGM metrics, including mean glucose, measures of hyperglycemia, and the coefficient of variation, by diabetes status. RESULTS Of the 1,150 participants (mean age 83 years, 59% women, 26% who are Black), 35.1% had normoglycemia, 34.5% had prediabetes, and 30.4% had diabetes. The summary 24-h ambulatory glucose profile for participants with prediabetes was very similar to those with normoglycemia. No participants with normoglycemia or prediabetes had a CGM mean glucose >140 mg/dL, while 32.7% of participants with diabetes had a CGM mean glucose >140 mg/dL. CONCLUSIONS In very old adults with normal or prediabetes HbA1c, hyperglycemia detected by CGM was rare. This suggests that HbA1c adequately captures the burden of hyperglycemia for most people in this population.
{"title":"Glucose Abnormalities Detected by Continuous Glucose Monitoring in Very Old Adults With and Without Diabetes","authors":"Natalie R. Daya, Michael Fang, Dan Wang, Arielle Valint, B. Gwen Windham, Josef Coresh, Justin B. Echouffo-Tcheugui, Elizabeth Selvin","doi":"10.2337/dc24-1990","DOIUrl":"https://doi.org/10.2337/dc24-1990","url":null,"abstract":"OBJECTIVE To characterize the prevalence of continuous glucose monitoring (CGM)-defined glucose abnormalities in a large, community-based population of very old adults (&gt;75 years). RESEARCH DESIGN AND METHODS A cross-sectional analysis of 1,150 older adults with and without diabetes who attended the Atherosclerosis Risk in Communities Study (2021–2022). Diabetes was based on a self-reported diagnosis of diabetes by a health care provider, use of diabetes medication, or a hemoglobin A1c (HbA1c) ≥6.5%. Prediabetes was defined as an HbA1c of 5.7% to &lt;6.5% and normoglycemia as an HbA1c of &lt;5.7%. We analyzed CGM metrics, including mean glucose, measures of hyperglycemia, and the coefficient of variation, by diabetes status. RESULTS Of the 1,150 participants (mean age 83 years, 59% women, 26% who are Black), 35.1% had normoglycemia, 34.5% had prediabetes, and 30.4% had diabetes. The summary 24-h ambulatory glucose profile for participants with prediabetes was very similar to those with normoglycemia. No participants with normoglycemia or prediabetes had a CGM mean glucose &gt;140 mg/dL, while 32.7% of participants with diabetes had a CGM mean glucose &gt;140 mg/dL. CONCLUSIONS In very old adults with normal or prediabetes HbA1c, hyperglycemia detected by CGM was rare. This suggests that HbA1c adequately captures the burden of hyperglycemia for most people in this population.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"48 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142867317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lori M. Laffel, Jennifer L. Sherr, Jingwen Liu, Wendy A. Wolf, Jeoffrey Bispham, Katherine S. Chapman, Daniel Finan, Lina Titievsky, Tina Liu, Kaitlin Hagan, Jason Gaglia, Keval Chandarana, Jeremy Pettus, Richard Bergenstal
OBJECTIVE We captured continuous glucose monitoring (CGM) metrics from a large online survey of adults with type 1 diabetes to determine how glycemic outcomes varied by insulin delivery form. RESEARCH DESIGN AND METHODS Adults with type 1 diabetes from the T1D Exchange Registry/online communities completed the survey and contributed retrospective CGM data for up to 1 year. Self-reported glycemic outcomes and CGM measures were described overall and by insulin delivery method. RESULTS The 926 participants completed the survey and provided CGM data. Mean ± SD age was 41.9 ± 15.7 years, and 50.8% reported using automated insulin delivery (AID). While AID users spent more time in range, 27.9% did not achieve time in range targets, 15.5% reported severe hypoglycemic events (SHEs), and 16.0% had CGM-detected level 2 hypoglycemic events. CONCLUSIONS Despite use of diabetes technologies, many individuals are unable to achieve glycemic targets and experience severe hypoglycemia, highlighting the need for novel treatments.
{"title":"Limitations in Achieving Glycemic Targets From CGM Data and Persistence of Severe Hypoglycemia in Adults With Type 1 Diabetes Regardless of Insulin Delivery Method","authors":"Lori M. Laffel, Jennifer L. Sherr, Jingwen Liu, Wendy A. Wolf, Jeoffrey Bispham, Katherine S. Chapman, Daniel Finan, Lina Titievsky, Tina Liu, Kaitlin Hagan, Jason Gaglia, Keval Chandarana, Jeremy Pettus, Richard Bergenstal","doi":"10.2337/dc24-1474","DOIUrl":"https://doi.org/10.2337/dc24-1474","url":null,"abstract":"OBJECTIVE We captured continuous glucose monitoring (CGM) metrics from a large online survey of adults with type 1 diabetes to determine how glycemic outcomes varied by insulin delivery form. RESEARCH DESIGN AND METHODS Adults with type 1 diabetes from the T1D Exchange Registry/online communities completed the survey and contributed retrospective CGM data for up to 1 year. Self-reported glycemic outcomes and CGM measures were described overall and by insulin delivery method. RESULTS The 926 participants completed the survey and provided CGM data. Mean ± SD age was 41.9 ± 15.7 years, and 50.8% reported using automated insulin delivery (AID). While AID users spent more time in range, 27.9% did not achieve time in range targets, 15.5% reported severe hypoglycemic events (SHEs), and 16.0% had CGM-detected level 2 hypoglycemic events. CONCLUSIONS Despite use of diabetes technologies, many individuals are unable to achieve glycemic targets and experience severe hypoglycemia, highlighting the need for novel treatments.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"11 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142858453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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